P - 76063REQUEST FOR ELECTRICAL INSPECTION
1� 7 8 7� 0 7 0 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800TTY/MRS 1-800-627-3529 www.elecri-iciry.state.mn.us
Describe -using the back of the,pvhite copy'rf ne�,c�.the v�ork�ug�dby t�i��t; ��� � TC H
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IICATION, REMOTE CONTROL, SIGNALING
ITS OF LESS THAN 50 VOLTS
Device or Apparatus a�. $.50
Fixture
Mile
1Y BE
1 IIH II III II Ili II III � i� II I�I II �I ��I II III I IIII
178707U0
Outdoor Liahtina Standard
Transfortners u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer I Power Supply for Signs I Outline Lighting @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
thatl
IF
TOTAL FEE
total fee is $201
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the elechical installetlon described herein on the dates steted:
COMPLETED WITHIN 12
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�' Rough-in Inspection Required7 ❑Ye �] No Inspection OtherThan Rough-In: �Ready Now ❑Will Call
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You must csll the inspector when ready! Date Ready:
I cer�y �a� I am the L1 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electric�l work at
M/STRI1CT10N3 ON BACK OF YELLOW COPY BOAR� C7F FI FC:TRI(:ITY (:(7PV G2nmm� e_�c n e onnn